Duret hemorrhage is characterized by an upper brainstem hemorrhage due to increased intracranial pressure by mass effect such as subdural hematoma or a brain tumor. The anteroposterior elongation and downward displacement of the upper brainstem by transtentorial herniation results in the compression and tearing of the paramedian perforating vessels that feed the upper brainstem tegmentum. The consequent hemorrhage that involves the upper brainstem renders recovery to be almost impossible. Following a tricuspid valve replacement surgery, a 56-year-old woman developed a left fronto-temporo-parietal nontraumatic subdural hematoma resulting in transtentorial herniation of the left mesial temporal lobe. A successful surgical evacuation of the hematoma was done with clinical improvement. Two days later, she was referred to neurology with an aggravated right side weakness, dysarthria, and a newly developed extraocular movement disturbance. A brain CT and MRI showed a pontine hemorrhage. We report a case of pontine hemorrhage, a Duret hemorrhage, after the surgical evacuation of nontraumatic subdural hematoma.
Brain ; Brain Neoplasms ; Brain Stem ; Dysarthria ; Female ; Hematoma ; Hematoma, Subdural* ; Hemorrhage* ; Humans ; Intracranial Pressure ; Magnetic Resonance Imaging ; Middle Aged ; Neurology ; Temporal Lobe ; Tricuspid Valve

We assessed about growth hormone binding proteins (GHBP) activity which was measured eluted biotin GH fraction with alkaline phosphatase-streptavidine in children with insulin dependent diabetes mellitus (IDDM), short stature due to growth hormone deficiency (GHD), chronic renal failure, short stature due to nutritional deficiency. hypothyroidism and normal control groups using high pressure liquid chromatography protein pak 300 sw column. The following results are observed: 1) There were 3 types of growth hormone (GH) in serum: first GH binded with type I (minor) GHBP suggesting 200K dalton of molecular weight, second GH binded with type II (major) GHBP suggesting 60~70K dalton of molecular weight, and third GH were free form GH suggesting 20~25K dalton of molecular weight. 2) Type II (major) GHBP showed considerable individual variation in all ages. Neonates had the lowest levels of GHBP activity, but by the puberty the levels had increased & remained stable from adolescent to adult periods. 3) GHBP activity of children with IDDM at diagnosis was low value as compared to the same agenormal control group (p<0.05), and difference of GHBP activity among children with IDDM was related with height velocity (r=+0.92). Follow up GHBP activity during insulin therapy was reverse correlation with HbAlc. 4) GHBP activity of children with GHD at diagnosis was a slightly low compared to aged matched control and follow-up GHBP activity after 1 dose GH therapy showed increasing tendency (r=-0.68). 5) Otherwise, children with chronic renal failure, short stature due to nutritional deficiency, and hypothyroidism were assessed lower value than normal control group. Above results, GHBP activity had the lowest levels at neonatal period and then increasing tendency until puberty period and remained steady level until adult period. Regulation of GHBP may be closely related with metabolic control state by insulin, GH, nutritional status, and thyroid hormone..
Adolescent ; Adult ; Biotin ; Carrier Proteins ; Child ; Chromatography, Liquid ; Diabetes Mellitus ; Diabetes Mellitus, Type 1 ; Diagnosis ; Follow-Up Studies ; Growth Hormone ; Humans* ; Hypothyroidism ; Infant, Newborn ; Insulin ; Kidney Failure, Chronic ; Malnutrition ; Molecular Weight ; Nutritional Status ; Puberty ; Thyroid Gland

No abstract available.
Hormone Replacement Therapy ; Humans ; Incheon* ; Osteoporosis* ; Physicians, Primary Care* ; Primary Health Care*

PURPOSE: We wanted to evaluate the relationship among the myelography, magnetic resonance imaging (MRI), and electromyography (EMG) findings in young patients with low back pain, and we wanted to assess the significance of the spinal geometric measurements as well as type of disc herniation seen on MRI. MATERIALS AND METHODS: Forty-four young men with lower back pain were included, and they were all clinically suspected of suffering with lumbar disc herniation. All of them underwent myelography, MRI and EMG. We measured spinal geometry including the anteroposterior diameters of the central canal and thecal sac, the interlaminar distance, the width of the lateral recess and the thickness of the ligamentum flavum, and we evaluated for root deviation as well as disc herniation on the MRIs. We compared the types of disc herniation on MRI with the myelography and EMG findings. Also, we investigated the correlation of the spinal geometric measurements on MRI with the EMG and myelography findings. RESULTS: The types of disc herniation on MRI were not significantly related to the myelography (p = 0.298) and EMG findings (p = 0.372). The EMG findings were not related to either the myelography findings (p = 0.435) or the spinal geometric measurements (p > 0.05) on MRI. Nerve root compression that was noted on myelography was related to the thecal sac AP diameter (p = 0.016) and the width of the lateral recess (p = 0.011). There were no correlations between myelography and the findings of root deviation on MRI (p=0.052). CONCLUSION: MRI can play an excellent diagnostic role for young patients with radiculopathy or lower back pain. It could increase the diagnostic accuracy if it is used in conjunction with myelography and EMG. The narrowing of thecal sac AP diameter and the width of lateral recess rather than the type of disc herniation on MRI were well correlated with the myelography and EMG findings.
Electromyography ; Humans ; Ligamentum Flavum ; Low Back Pain* ; Magnetic Resonance Imaging* ; Male ; Myelography* ; Radiculopathy ; Spine

Cystic lymphangioma is uncommon angiomatous tumor that mainly occurs in the neck. Less than 1% of these tumors affect the mesentery, retroperitoneum and greater omentum. In particular, the cystic lymphangioma involving the mesentery and the retroperitoneum is a rare lesion. We report here on an uncommon case of cystic lymphangioma that presented as a multilocular mass involving the mesentery and the retroperitoneum, and we also present a brief review of the relevant literature.
Lymphangioma ; Lymphangioma, Cystic* ; Mesentery* ; Neck ; Omentum

When vitrectomy is performed in eyes that have undergone glaucoma surgery, the site of sclerotomy often overlaps with the previous glaucoma operation site. It can lead to serious complications such as postoperative hypotony, leakage, and/or infection. Our technique involves modification of surgeon's position and two sclerotomy sites 45° away from the original position, with an infusion cannula inserted infranasally to avoid damage to the glaucoma drainage implant or filtering bleb. The modified approach was applied to seven eyes with various indications. Vitrectomy was successfully completed, and there were no sclerotomy site complications, leakage, or hypotony in any case. Good intraocular pressure control was maintained throughout the postoperative course in all cases.
Blister* ; Catheters ; Filtering Surgery ; Glaucoma Drainage Implants* ; Glaucoma* ; Humans ; Intraocular Pressure ; Vitrectomy*

Lung cancer causes the most cancer deaths in Korea. Although the smoking rate has begun to decrease, the prevalence of lung cancer is still increasing. We reviewed the national lung cancer registry data and the data published about lung cancer in Korea. In 2012, the crude incidence rate of lung cancer was 43.9 per 100,000. The age-standardized mortality rate of lung cancer was 19.8 per 100,000. The 5-year relative survival rate for lung cancer was 11.3% from 1993 to 1995 and increased to 21.9% in the period from 2008 to 2012. Lung cancer occurring in never-smokers was estimated to increase in Korea. Adenocarcinoma is steadily increasing in both women and men and has replaced squamous cell carcinoma as the most common type of lung cancer in Korea. In patients with adenocarcinoma, the frequency of EGFR mutations was 43% (range, 20%-56%), while that of the EMK4-ALK gene was less than 5%.
Adenocarcinoma ; Carcinoma, Squamous Cell ; Epidemiology* ; Female ; Humans ; Incidence ; Korea* ; Lung Neoplasms* ; Lung* ; Male ; Mortality ; Prevalence ; Smoke ; Smoking ; Survival Rate

Nedocromil sodium is an anti-inflammatory medication for the treatment of mild to moderate asthma. The most common side effect of the nedocromil sodium is an unpleasant and bitter taste. However it is rare, less than 3%, to stop the treatment because of this side effect. Other side effects includes cough, headache, throat irritation and nausea which are reported as mild and transient. A 7-year-old female had a severe headache and dizziness during the treatment of asthma with nedocromil sodium. The symptoms subsided after nedocromil sodium was replaced by budesonide. We experienced a case of a severe headache and dizziness due to nedocomil sodium that lead to withdraw of the nedocromil sodium.
Asthma ; Budesonide ; Child ; Cough ; Dizziness* ; Female ; Headache* ; Humans ; Nausea ; Nedocromil* ; Pharynx ; Sodium

Fexofenadine is useful in various allergic disease treatment.However,the pharmacokinetic variability information and quantitative factor identification of fexofenadine are very lacking.This study aimed to verify the validity of previously proposed genetic factors through fexofenadine population pharmaco-kinetic modeling and to explore the quantitative correlations affecting the pharmacokinetic variability.Polymorphisms of the organic-anion-transporting-polypeptide(OATP)1B1 and 2B1 have been proposed to be closely related to fexofenadine pharmacokinetic diversity.Therefore,modeling was performed using fexofenadine oral exposure data according to the OATP1B1-and 2B1-polymorphisms.OATP1B1 and 2B1 were identified as effective covariates of clearance(CL/F)and distribution volume(V/F)-CL/F,respectively,in fexofenadine pharmacokinetic variability.CL/F and average steady-state plasma con-centration of fexofenadine differed by up to 2.17-and 2.20-folds,respectively,depending on the OATP1B1 polymorphism.Among the individuals with different OATP2B1 polymorphisms,the CL/F and V/F differed by up to 1.73-and 2.00-folds,respectively.Ratio of the areas under the curves following single-and multiple-administrations,and the cumulative ratio were significantly different between OATP1B1-and 2B1-polymorphism groups.Based on quantitative prediction comparison through a model-based approach,OATP1B1 was confirmed to be relatively more important than 2B1 regarding the degree of effect on fexofenadine pharmacokinetic variability.Based on the established pharmacokinetic-pharmacodynamic relationship,the difference in fexofenadine efficacy according to genetic poly-morphisms of OATP1B1 and 2B1 was 1.25-and 0.87-times,respectively,and genetic consideration of OATP1B1 was expected to be important in the pharmacodynamics area as well.This population phar-macometrics study will be a very useful starting point for fexofenadine precision medicine.

Purpose: This study was conducted to analyze the social factors influencing the ‘authenticity of suicidal ideation’ based post-suicidal care programs in emergency departments (EDs). Methods: This retrospective study was an analysis using the data of patients who had attempted suicide and visited the ED in tertiary urban hospitals from January 1, 2016, to December 31, 2018. The variables examined included gender, age, history of previous psychiatric disease, suicide method, and the number of previous attempts. Univariate and multivariate logistic regression analyses were conducted to identify factors influencing the registration rate for the community-based post-suicide care program. Results: Overall,1,460 suicides were analyzed, 177 (1.16%) showed a high authenticity of suicide. The social factors influencing the authenticity of suicide intent were the unmarried status of men and women, joblessness, history of mental illnesses, more than two previous suicide attempts, the influence of alcohol, and an attempt to commit suicide after midnight more specifically between 24:00 to 6:00 hours in the morning (p<.05). The factors influencing the severity of the condition of high authenticity suicide patients were low Glasgow coma scores (12 points or less), lactate levels, and oxygen saturation observed in the patients who were admitted to the intensive care unit for treatment and died (p<.05). Conclusion The need for evidence-based preventive measures and early assessment tools at the emergency medicine level is emphasized to reduce the rate of suicide attempts. If the results of this study are used in the management of suicide prevention, the evaluation of the authenticity of suicide intent will be more likely to be made at the emergency medicine level, allowing the severity to be assessed earlier.